Surgical techniques: Operative decompression using the transaxillary approach for NTOS

The transaxillary approach for thoracic outlet decompression has often been criticized as a treatment option for neurogenic TOS because of the perceived lack of ability to resect the posterior aspect of the first rib, thus incompletely decompressing the immediate vicinity of the brachial plexus, and inability to fully resect the anterior scalene muscle. This chapter is intended to demonstrate how we safely approach NTOS using the transaxillary approach and remove the first rib in its near entirety to achieve optimal decompression of the thoracic outlet.